(1) fluids for exam 3 NRSG 1200

fluid body percentage by age: full term newborn vs >60 elderly

70-80% vs 45-50%

insensible fluid loss

not measurable by ordinary means: feces, perspiration, lungs, skin

ADH fluid regulation

increased osmolarity triggers the posterior pituitary to release ADH which tells the kidneys to retain water

Aldosterone fluid regulation

decreased renal perfusion causes the RAAS system to release aldosterone to retain water

ANP fluid regulation

overstretched heart releases ANP which blocks renin/aldosterone and ADH leading to increased sodium and urine output

oncotic pressure

colloidal pressure; pull by things with high molecular weight to keep things in the intravascular space

osmotic pressure

pull of electrolytes that draws fluids through a semipermeable membrane

hydrostatic pressure

pressure that forces fluid out of a vessel

isotonic fluids

0.9% NS, LR

hypotonic fluids

D5W, 0.45% NS

hypertonic fluids

colloids, 5% dextrose in 0.45/0.9% NS, 3% NS

colloids

albumin, hetastarch, blood products

crystalloids

mineral ions dissolved in water: LR, NS, D5W

hypovolemia causes/risk factors

NPO, trauma, GI losses, disorientation, elderly age, bleeding, dehydration, third spacing

hypovolemia s/s

poor skin turgor, hypotension, tachycardia, tachypnea, weak pulses, weight loss, loc changes

hypovolemia complications

ATN, DVT/clotting, kidney stones, angina, shock

hypovolemia NI

monitor I/Os, specific gravity, osmolarity, increase fluids with electrolytes, treat s/s, etc.

hypervolemia causes/risk factors

HF, renal/liver dysfunction, adrenal dysfunction, hormonal imbalances, excessive fluid/salt intake, medications

hypervolemia s/s

weight gain, lung sounds, edema, JVD, activity intolerance, bounding pulse, HTN, tachycardia, tachypnea, SOB

hypervolemia complications

cardiac/respiratory issues, pitting edema

hypervolemia Tx

restrict fluids/sodium, diuretics, etc.

hypervolemia NI

monitor I/Os, daily weight, electrolyte levels, s/s of worsening, compression stockings, teach dietary changes & early s/s

third spacing cause/risk factors

abdominal surgery, liver disease, burns, sepsis, trauma, lymphatic obstruction, etc.

third spacing s/s

hypovolemia s/s + weight gain, brawny edema, thready pulse, ascites, anasarca

third spacing complications

same as hypovolemia + possible hypervolemia

third spacing Tx

IV colloids, diuretics, treat cause

third spacing NI

I/Os, daily weights, hypo/ervolemia s/s, assess albumin & electrolyte levels, teach worsening s/s & proper nutrition